Brittany Maynard ends her life

Prayer vigils and outreach efforts did not fail her. The assisted suicide movement did.

Brittany Maynard was the perfect poster child that movement never had before, short of Hollywood films such as ‘Million Dollar Baby’, ‘You Don’t Know Jack’, ‘Sanctum’, ‘Amore’, and probably others. But those were slick productions, successful as they were in advancing the notion that ‘death with dignity’ was something saleable. They marketed it so well, the idea grew in the public consciousness, among more Americans, that maybe people should be able to have the choice to end their life if they were suffering.

Trouble is, there’s too much wrong with that idea to properly handle quickly enough to reach someone who comes along with a serious diagnosis of a terminal illness and has been stricken to the core with fear. Like Brittany Maynard.

So in the immediate aftermath of this sad but highly publicized story of human vulnerability, suffering, hope and a condition posed as ‘hopelessness’, here are some considerations of friends and colleagues I call on for bioethics stories regularly, who have taken keen interest in the Brittany Maynard story since it first surfaced, but more importantly, in the young woman herself.

Nurse Nancy Valko in The Public Discourse, a week ago:

Groups supporting physician-assisted suicide now call the promotion of Ms. Maynard’s story “a tipping point” in their decades-long push to gain public support for changing laws.

They have needed such a high profile case supporting their cause, because it so profoundly goes against our society’s Judeo-Christian ethic of life.

Society has long insisted that healthcare professionals adhere to the highest standards of ethics, as a protection for society. Without that clear moral compass, it has been said, the physician is the most dangerous man in society. The vulnerability of a sick person, and the inability of society to monitor every healthcare decision or action, are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Erasing the bright line doctors and nurses have drawn for themselves—which separates killing from caring—is a decision fraught with peril, especially for those who are most vulnerable.

As a nurse, I am willing to do anything for my patients—but I will not kill them nor help them kill themselves. In my work with the terminally ill, I have been struck by how rarely such people say anything like, “I want to end my life.” I have seen the few who do express such thoughts become visibly relieved when their concerns and fears are addressed, instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.

Valko’s decades-long experience as an acute care nurse, steeped in end-of-life care and palliative care and other issues of medical ethics, gives her far deeper insight and expertise on these issues and the human vulnerabilities involved in them, than agenda driven advocates can access.

Do assisted suicide supporters really expect us doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on our ethics or our empathy? Do they realize that this reduces the second patient’s will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves?

Stories like Brittany Maynard’s can feed into a society that is fascinated by tragic love stories, but does not understand how such stories are used as propaganda to promote a dangerous political agenda that can affect us all—and our loved ones.

Personally, I will continue to care for people contemplating suicide or who have made an attempt regardless of their age, condition, or socio-economic status. I reject discrimination when it comes to suicide prevention and care. I hope our nation will do so as well.

Even, and especially, with Brittany Maynard carrying out her plans to end her life  on her terms, at a time of her choosing, for the sake of what she saw as autonomy. The group formerly known as ‘The Hemlock Society’, now known as ‘Compassion and Choices’, claims victory in this assisted suicide.

Advocacy group Compassion & Choices spokesman Sean Crowley on Sunday afternoon said he could not confirm Maynard’s death “in respecting the family’s wishes.”

He added that Maynard “is educating a whole new generation on this issue. She is the most natural spokesperson I have ever heard in my life. The clarity of her message is amazing. She is getting people to consider this issue who haven’t thought of it before. She’s a teacher by trade and, she’s teaching the world.

But what is her death by assisted suicide teaching the world?

Before it happened, noted bioethics expert Wesley J. Smith wrote this (read the whole piece, written while she was still contemplating suicide):

To put it bluntly, whether to legalize physician-prescribed suicide is about much more than Brittany Maynard’s individual circumstances, as tragic and emotionally compelling as that may be.”

Now that her own plight has ended in tragic circumstances of suicide, Smith only said this, for now:

I know that I am supposed to keep quiet and simply offer condolences. Frankly, I doubt her family would want them from me–given how her illness and death were politicized in the cause of using our great empathy for her to demolish laws against doctor-prescribed death and my implacable opposition to that dark agenda.

But, of course, I am saddened. Who wouldn’t be? Her cancer and death, if the report is accurate, are a terrible tragedy. I wish her husband, family, and friends nothing but the best.

Expect suicide advocates to now use her death to stoke emotions even higher around the assisted suicide debate. But emotionalism is the last approach that should be taken in pondering such a radical, culturally transforming agenda and the impact legalization would have and its potential impact on the most weak and vulnerable.

They need our help, everyone’s help, in living natural life to the fullest with the utmost help and companionship for the trial and journey, our help ‘suffering with’ them, otherwise known as true compassion. Not our help in hastening death.

Patients rights in America

Let’s focus on Wisconsin here, as a microcosm of the morphing healthcare system that’s redefining health and care and prompting an effort to examine it all carefully.

The Wisconsin bishops released a statement warning people about the spreading use of Physician (or Provider) Orders for Life-Sustaining Treatment (POLST). They did it in a carefully but clearly worded pastoral letter Upholding the Dignity of Human Life.

A POLST form presents options for treatments as if they were morally neutral. In fact, they are not. Because we cannot predict the future, it is difficult to determine in advance whether specific medical treatments, from an ethical perspective, are absolutely necessary or optional. These decisions depend upon factors such as the benefits, expected outcomes, and the risks or burdens of the treatment.

A POLST oversimplifies these decisions and bears the real risk that an indication may be made on it to withhold a treatment that, in particular circumstances, might be an act of euthanasia. Despite the possible benefits of these documents, this risk is too grave to be acceptable.

Finally, the design and use of the POLST document raises concerns as to whether it accurately reflects and protects a person’s wishes.

These have all been concerns for years in the medical/legal system, which became a riveting national debate while Terri Schiavo was being starved and dehydrated to death. It also became a discussion around a lot of family tables across the country at that time, causing a lot of media coverage of things like ‘living wills’ and a lot of Americans to rush to arrange them or sign already prepared ones that appeared online in a number of places.

Don’t do that, say the bishops and the experts at the Patients Rights Council and Terri’s Life and Hope Network, among others.

The pastoral statement:

We encourage all persons to use a durable power of attorney for health care. For those who are age 18 or older, completing this document allows you to appoint a trusted person to make health care decisions on your behalf if a situation arises in which you cannot make these decisions for yourself. It is important to discuss your wishes and Catholic teaching with the person whom you appoint and to choose someone who will make health care decisions based on these principles.

The Patients Rights Council site is loaded with resources, for people of any state in the nation and in life and belief system. Just don’t let others take your treatment decisions away from you and determine them for you, in the absence of your advance directive. PRC’s Rita Marker told me people can get a Protective Medical Decisions Document at their site, no charge (suggested donation encouraged). More on that here.

I’ve worked for years with Terri Schiavo’s family, since they were trying to save her life and just take her home and care for her. They devoted the rest of their lives to helping other families avoid that ordeal with information and resources. And first hand relief efforts.

And still in recent years and even months and weeks, I’ve known or known of families caught in the pressure of having to make medical decisions they weren’t prepared for, wondering who had what authority (or why they didn’t have the rights they thought) while their loved ones died.

But none of them were from TMI. We can’t be too well informed.

Baby Joseph battles

The hospital involved in this sad story is representing itself as allowing the family’s wishes to take their child home to die there instead of in the stark atmosphere of the medical facility. And some news stories have reported that the parents are getting their wish, after all. Not exactly true…

Here’s the most thorough account at the moment.

…the hospital where Joseph is being kept said it is willing to send him home, but with an important catch: they still refuse to perform the tracheostomy that allowed a sibling of Joseph’s who had a similar condition to live another six months at home. Instead they will simply return Joseph home, and then remove his ventilator, after which he will almost certainly die within a matter of minutes…

Alex Schadenberg of the Euthanasia Prevention Coalition, who has been working closely with the family, told LSN that this solution is unacceptable to them…

“They need to do a tracheostomy,” said Dr. Paul Byrne, an Ohio neonatologist with nearly five decades of experience and a former president of the Catholic Medical Association.  “If the baby is stable otherwise, and has a tracheostomy, then the baby can be taken care of at home.”…

Dr. Byrne called the attempt to have the state remove Joseph’s ventilator “terrible, absolutely terrible,” and insisted that in his fifty years in neonatology he’s never removed a child’s ventilator.  “I’ve never seen a time to turn off a ventilator,” he said.  “If a baby has a disease process that’s so bad that they’re going to die, then they die on the ventilator anyway.  So you don’t have to stop the ventilator.”

This is a very important clarification of the case and the issues involved.

He also criticized the common phrase “life support,” saying, “Life is either there or it’s not there. You don’t have to hold up the life.  What we do in medicine are actions … that support the vital activity of respiration.”

“Assuming doctors can do something to support the vital activities, we ought to do them,” he explained.  “And a tracheostomy ought to be done, and the baby ought to continue on the ventilator.”

Further clarification…

Though doctors have said Joseph is in a “vegetative state,” Dr. Byrne called it a “made-up term” similar to the notion of “brain death,” which he said was invented “simply to get beating hearts for transplantation.”

Even Joseph’s doctor in London has admitted that the tracheostomy could prolong his life.  “A tracheotomy would likely provide for a longer period of life, however, in our view would not result in improvement of well-being and could reduce quality of life,” Dr. Douglas Fraser told the Ontario Consent and Capacity Board in January.

Key phrases there, the baby’s “well-being” as seen “in our view,” that of hospital panels and government boards. That’s the scenario we’re all facing, increasingly, with health care rationing. The “quality of life” calculus doesn’t account for the sanctity of life.

Loved to death

Whether there are more Terri Schiavo’s suffering a torturous death by starvation and dehydration these days, or we’re just hearing more about them these days is uncertain. But the manner of such death should be made clear, and the media are certainly not doing that.

The latest case we know of is the ‘bride in a coma’ story. She was young and just married. But what we know through the media is incomplete about Trisha Rushing Duguay’s death is incomplete.

Just 27 years old, she had continued living, remarkably, for eight weeks after her husband and family had, according to her wishes, removed her feeding tube.

Trisha’s father, Jim Rushing, announced the news in an e-mail to family and close friends.

“Trisha has finally departed us on this physical journey to take her branch onto her spiritual journey. This journey has been 132 days in length 56 of those days off of life support. We know that not only her love & caring for others, but the sheer volume of prayer that has occurred will truly help her along this new path. Thank you.

That volume was generated through media coverage of this dramatic story and social communications media that spread it. The good news is that it generated a tremendous amount of prayer. The darker side of this story didn’t make it into the news coverage, as Terri Schiavo’s brother tried to warn people. Bobby Schindler writes:

Terri’s Life & Hope Network expresses concern with the manner in which some media outlets are portraying the situation, treating Trisha’s prolonged death and going without food and hydration-for over 7 weeks now-as an act of compassion.

I think it is important to be reminded that dying this way is not compassionate, peaceful or pleasant. My family witnessed, first hand, something quite the opposite. Terri went through almost two weeks without food and water before she died, and it was heartbreaking. Her death was cruel and barbaric and she suffered horribly. We must continue to educate the general public that food and water is basic and ordinary care and despite ones intentions, it does not change the nature of the act.

That’s a vital point. Food and water are not medical treatments, they’re ordinary care, no matter how they are redefined. People are very confused about this. Conscientious, faithful people are looking for moral guidance in making end of life decisions, and it’s available for all people concerned with preserving and respecting human dignity when it can be toughest to discern that process.